An evidence synthesis of the international knowledge base for new care models to inform and mobilise knowledge for multispecialty community providers (MCPs).

Background: NHS England's Five Year Forward View (NHS England, Five Year Forward View, 2014) formally introduced a strategy for new models of care driven by simultaneous pressures to contain costs, improve care and deliver services closer to home through integrated models. This synthesis focuses on a multispecialty community provider (MCP) model. This new model of care seeks to overcome the limitations in current models of care, often based around single condition-focused pathways, in contrast to patient-focused delivery (Royal College of General Practitioners, The 2022 GP: compendium of evidence, 2012) which offers greater continuity of care in recognition of complex needs and multimorbidity.

Development of a novel cell sorting method that samples population diversity in flow cytometry.

Flow cytometry based electrostatic cell sorting is an important tool in the separation of cell populations. Existing instruments can sort single cells into multi-well collection plates, and keep track of cell of origin and sorted well location. However currently single sorted cell results reflect the population distribution and fail to capture the population diversity.

Dial-in flow cytometry data analysis.

As listmode data files continue to grow larger, access via any kind of network connections becomes more and more trouble because of the enormous traffic generated. The limited speed of transmission via modem makes analysis almost impossible. This unit presents a solution to these problems, one that involves installation at the central storage facility of a small computer program called a Web servlet.

Measuring lymphocyte proliferation, survival and differentiation using CFSE time-series data.

Cellular proliferation is an essential feature of the adaptive immune response. The introduction of the division tracking dye carboxyfluorescein diacetate succinimidyl ester (CFSE) has made it possible to monitor the number of cell divisions during proliferation and to examine the relationship between proliferation and differentiation. Although qualitative examination of CFSE data may be useful, substantially more information about division and death rates can be extracted from quantitative CFSE time-series experiments.

Developmental kinetics and lifespan of dendritic cells in mouse lymphoid organs.

The labeling kinetics of 5 dendritic cell (DC) subtypes within the lymphoid organs of healthy laboratory mice during continuous administration of bromodeoxyuridine (BrdU) was determined to investigate developmental relationships and determine turnover rates. Individual DC subtypes behaved as products of separate developmental streams, at least as far back as their dividing precursors. The rate of labeling varied with the lymphoid organ and the DC subtype.

Web servlet-assisted, dial-in flow cytometry data analysis.

Background: The obvious benefits of centralized data storage notwithstanding, the size of modern flow cytometry data files discourages their transmission over commonly used telephone modem connections. The proposed solution is to install at the central location a web servlet that can extract compact data arrays, of a form dependent on the requested display type, from the stored files and transmit them to a remote client computer program for display.

Methods: A client program and a web servlet, both written in the Java programming language, were designed to communicate over standard network connections.

Single cell sorting and cloning.

Cell sorters now allow the selection of cells and other bodies according to a range of quite diverse criteria. The additional refinement that allows the sorting of individual cells based on these criteria has seen application in many fields of research. Single cells may be sorted for microscopy, for culture and for genetic analysis by way of single cell PCR (polymerase chain reaction).

Flow cytometry and cell-separation procedures.

A series of small incremental advances characterize the year's technical developments in flow cytometry, and these now extend the use of the technique to even the molecular level. The increasing application of immunomagnetic-bead separation procedures dominates the developments in other cell-separation procedures.

Nature of the thymocytes associated with dendritic cells and macrophages in thymic rosettes.

Thymic rosettes, structures consisting of 3-30 thymic lymphoid cells attached to a central macrophage or dendritic cell, were released from mouse thymus tissue by collagenase digestion. They were shown to be preexistent structures within the thymus, but to be subject to extensive exchange with free thymocytes under certain conditions. An isolation procedure was developed, using a new technique of zonal unit-gravity elutriation, which minimized exchange and produced a completely pure sample of the larger rosettes.

Clonal proliferation in vitro of individual murine and human hemopoietic cells after fluorescence-activated cell sorting.

A modification of the fluorescence-activated cell sorter (FACS) was used to rapidly and reliably study the clonal proliferation of single hemopoietic cells. Murine FDC-P1 and human cord blood progenitor cells were examined for their ability to proliferate from single cells in 96-well microtiter plates containing agar medium and appropriate stimuli. FACS-sorted FDC-P1 single cells formed colonies in 345 out of 558 wells (62%), which compared favorably with control cultures (53%) and micromanipulated single cells (55%).

Plasmodium falciparum: rapid quantification of parasitemia in fixed malaria cultures by flow cytometry.

A rapid and sensitive method is described for the determination of parasitemia in Plasmodium falciparum cultures using the fluorescence activated cell sorter and DNA-binding fluorochrome, 33258 Hoechst. Conditions were selected to permit its application to the screening of assays with numerous samples. Parasites suspended in culture medium were mixed with an equal volume of aqueous fixative (10% w/v formaldehyde, 4% w/v D-glucose in Tris-saline pH 7.

Clonal expansion of T cells: a cytotoxic T-cell response in vivo that involves precursor cell proliferation.

The response of peritoneal exudate lymphocytes to allogeneic tumor cells was used to determine whether the in vivo generation of cytotoxic T cells (CTL) involved the proliferation of precursor cells. Ten days post-injection, both cytotoxic activity and the formation of conjugates between lymphocytes and target cells were shown to be specific for the immunizing tumor alloantigens and to be effected by Ly-2+ cells. A cell-sorting-based procedure was developed to isolate specific conjugates between red-fluorescence-tagged CTL and blue-fluorescence-tagged tumor target cells.

A fast cell sampler for flow cytometry.

A simple device has been developed for delivering samples into a flow cytometer. Designed with economy, simplicity, and flexibility in mind, this device, having only one moving part, can be used for sample volumes as small as 20 microliter, for virtually any form of cell sample container, and for a wide range of cell concentrations. It consists essentially of a lever-operated disc valve that allows the cell sample to be loaded into a loop of tubing and then to be injected into the cytometer nozzle under pressure from a saline source.

Fc receptors on mouse neutrophils and eosinophils: antigenic characteristics, isotype specificity and relative cell membrane density measured by flow cytometry.

The antigenic characteristics, isotype specificity and density of Fc receptors (FcR) on mouse neutrophils and eosinophils were studied with the aid of the rat monoclonal antibody 2.4 G2 to the mouse macrophage FcR (Unkeless, 1979). This MAb was tested for its reactivity with mouse neutrophil and eosinophil FcR, and for its ability to block the binding of sheep erythrocytes (E) coated with mouse antibodies of different isotypes to granulocytes.

Phenotypic diversity of cloned lines of Leishmania major promastigotes.

In vitro cultured promastigotes of virulent (V) and avirulent (A) cloned lines of Leishmania major, and the parental isolate LRC-L137, were examined with respect to morphology, cell size, growth rate, and apparent DNA content. Growth rates of all lines were comparable and both virulent (V121, LRC-L137) and avirulent parasites (A12, A52, A59) exhibited a progressive decrease in apparent DNA content with time in culture, as measured by incorporation of Hoechst Dye 33342. The four cloned lines and the parental isolate showed differences in the content of morphological variants and in the mean body length.

Inducible expression of H-2 and Ia antigens on brain cells.

Cells in the brain express unusually low levels of antigens encoded by the major histocompatibility complex (MHC). This is somewhat surprising as class I (H-2) and class II (Ia) MHC antigens have critical roles in immune responses. The activation of T lymphocytes is associated with the enhanced expression of these antigens and this effect is mediated by a specific T-cell lymphokine, gamma-interferon (IFN-gamma).

Activation of granulocyte cytotoxic function by purified mouse colony-stimulating factors.

Highly purified mouse colony-stimulating factors (CSF) were tested for their effect on neutrophil cytotoxic function in a homologous antibody-dependent cell-mediated cytotoxicity (ADCC) assay in which TNP-coupled mouse thymoma cells coated with mouse anti-TNP antibodies were used as targets, and purified normal mouse bone marrow neutrophils or induced peritoneal neutrophils were used as effector cells. Biochemically pure granulocyte-macrophage (GM)- and granulocyte (G)-CSF enhanced the cytotoxic activity of neutrophils obtained from both sources, allowing them to kill target cells at low antibody concentrations. Furthermore, GM- and G-CSF showed an additive effect, suggesting either the presence of separate receptors for GM- and G-CSF or of separate subsets of neutrophils.

Eosinophil activation by colony-stimulating factor in man: metabolic effects and analysis by flow cytometry.

Substantial increases in the killing capacity of human eosinophils after in vitro incubation with human placental conditioned medium (HPCM), a standard source of colony-stimulating factor (CSF), have recently been described. In this article, the interaction between HPCM and purified human eosinophils is analyzed by flow cytometry and by effects on iodination, superoxide production, and protein synthesis. HPCM increased the intensity of natural eosinophil autofluorescence (aFlu) (460 nm) after the absorption of ultraviolet light (360 nm) in a manner that was both time and dose dependent.

Intramucosal lymphocytes of the gut: Lyt-2 and thy-1 phenotype of the granulated cells and evidence for the presence of both T cells and mast cell precursors.

The gut mucosa contains lymphocyte-like cells, a proportion of which contain a small number of granules that resemble those of mast cells in that they contain histamine and stain metachromatically. It has been suggested that these granulated lymphocytes represent transitional forms in the differentiation of T cells into mast cells. We used monoclonal antibodies and the fluorescence-activated cell sorter to analyze the expression of Thy-1 and Lyt-2 antigens on gut intramucosal lymphocytes with particular emphasis on the granulated cells.

Expression of Thy-1 antigen is not limited to T cells in cultures of mouse hemopoietic cells.

Large numbers of Thy-1-positive cells were observed in cultures of bone marrow cells that had been depleted of T cells and grown for 3 to 4 days in the presence of medium conditioned by concanavalin A-activated spleen cells. Cells bearing levels of Thy-1 comparable with those on the bulk of thymocytes were isolated by using the fluorescence-activated cell sorter. Although many were large blasts, the Thy-1-positive cells failed to grow in response to T-cell growth factor and concanavalin A; about one-third, however, proliferated in the presence of factors stimulating hemopoietic progenitor cells.

Separation of stages of Plasmodium falciparum-infected cells by means of a fluorescence-activated cell sorter.

Plasmodium falciparum parasites from long-term in vitro culture have been labeled with the DNA-binding dye Hoechst 33258. After labeling, parasitized cells have been successfully analyzed and sorted, using a fluorescence-activated cell sorter, into populations of uninfected, singly infected, and multiply infected cells.